About the service:

Bloomsbury Homecare Limited is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Bourne, Stamford, Spalding and Grantham. At the time of the inspection visit there were 106 people using the service.

People’s experience of using this service:

• Systems were in place to ensure the safety of people being cared for.

• Risks were assessed and appropriately managed.

• Medicines were administered safely and in line with policies and procedures.

• Safeguarding issues and complaints were reflected upon and improvements were made.

• People’s needs were assessed and outcomes were met.

• Staff received the mandatory training they needed to meet people’s basic needs. Some improvements needed to be made to ensure that staff were provided with more detailed knowledge relating to specific conditions such as dementia.

• People’s consent to care was sought.

• The care staff and the managers reflected the values of the organisation.

• People were given the opportunity to express their views regularly and were involved in the planning of their care.

• Care staff demonstrated a good awareness of how to maintain people’s privacy and dignity.

• People were receiving care that was responsive to their needs. Some improvements needed to be made to ensure that people were routinely called when their care call was likely to be delayed.

• People were consulted about the care they received and were asked for regular feedback. Some improvements needed to be made so people could find out about what was being done in relation to their concerns.

• Care plans were being developed to include more person-centred information.

• Care was delivered by staff who understood the needs of the people they were supporting.

• People knew how to complain and raise concerns and were listened to and responded to.

• Leadership of the service was strong. Care staff were very complimentary of the support they received from the registered manager. Morale in the team was good and there was a good team working ethos.

• Processes were in place to ensure that the delivery of care was monitored and checked regularly. Plans for improvement were implemented and actioned.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement and was published on 7 April 2017.

Why we inspected:

This was a scheduled inspection based on previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Bloomsbury Homecare Limited Bourne provides care for adults of all ages in their own homes. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs, a physical disability and/or who misuse drugs and alcohol. At the time of our inspection the service was providing care for 310 people most of whom were older people. The service covered Stamford, the Deepings, Bourne, Spalding and Grantham and surrounding villages. Between 1 January 2017 and 9 February 2017 (inclusive) the service completed 29,940 visits to people at home. This was made up of 11,731 to people living in Stamford and the Deepings and 12,966 to people living in Bourne. In addition, 3076 visits were completed in Spalding and there were 2167 visits in Grantham.

The service was run by a private company that was the registered provider. The chief executive of the company was also the nominated individual. This is a legal role that means the chief executive was responsible for assuring us that the service was well run. There was also a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection between 4 and 8 July 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2008. These breaches were because the registered persons had not reliably ensured that visits were carried out as planned and people had not always been supported to manage their medicines in a safe way. In addition, some people had not consistently been assisted to eat and drink enough. Further problems had been shortfalls in the way new care staff were recruited and mistakes that had been made in the way complaints were resolved. Another shortfall was the registered persons not telling us about significant events that had happened in the service. This oversight had reduced our ability to make sure that people were kept safe. All of these problems resulted from the registered persons not having rigorous quality checks in place so that shortfalls in the running of the service could quickly be put right.

After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 31 December 2016.

At this inspection we found that although improvements had been made to the deployment of staff, visits were not always being completed in the right way. This was because some visits had not been undertaken at the right time while others had not been completed at all. As a result there was a continuing breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered persons to take at the end of our report.

Although improvements had been made in relation to three of the other breaches, we also found that further progress was needed. This was so that people were always safely assisted to manage their medicines and were reliably supported to eat and drink enough. In addition, we concluded that quality checks needed to be still more robust so that remaining problems in the running of the service could quickly be put right.

In relation to the remaining two breaches, we found that sufficient improvements that had been made to the way in which new care staff had been recruited. We also noted that notifications had been submitted